Grandparenting and health in Europe: a longitudinal analysis Di Gessa G, Glaser K and Tinker A Institute of Gerontology, Department of Social Science, Health & Medicine, King’s College London United Kingdom

Outline Background Aim and objectives Data and Methods Results Conclusion

Background Grandparents play crucial role in family life Evidence of the impact of childcare on grandparents’ health is mixed:  Custodial/Primary grandchild carers experience poorer health;  Higher quality of life, lower depression and loneliness among grandparents providing grandchild care (vs no care).

Background /2 Most studies are cross-sectional and samples consist mostly of US grandparents; Focus on primary and custodial care; Few longitudinal studies have explicitly accounted for attrition.

Aim and objectives Examine the effects of caring for grandchildren on health among European grandparents. Main objective: to analyse longitudinal associations between grandparental childcare (including stability and change in provision) and self-rated health, ADL limitations, and depression two, and four years later.

Data 4 waves of multidisciplinary comparable surveys, representative of individuals 50+ – Survey of Health, Ageing and Retirement in Europe (SHARE) (N~27,000); France, Austria, Germany, Sweden, Denmark, Switzerland, The Netherlands, Italy, Spain, Belgium – Household response rate: 62%, with individual response rates higher than 85%; – First wave collected in 2004/05.  Focus on grandparents

Data /2 Waves 1, 2, and 4 provide information on grandparents, including: Demographic and socio-economic characteristics (age, marital status, occupational status, education) Health (depression, self-rated health -SRH, cognitive function, chronic diseases, functional limitations) Household characteristics (wealth, living arrangements, coresidence) Wave 3 only provides info on grandparents’ SRH

Methods /1  Using a sample of 14,675 grandparents aged 50+ from SHARE, and controlling for baseline covariates and health we examined: i.The longitudinal relationship between childcare provision at w2, and SRH/functional limitations/depression 2 and 4 years later; ii.The longitudinal relationship between stability and change in childcare provision (w1-w2) and subsequent health (w3, w4).

Methods /2 Provision of grandchild care « During the last 12 months, have you looked after your grandchild[ren] without the presence of the parents? » If so, i) « how often ?» [daily, weekly, monthly, less often] ii) « about how many hours ?» Intensive grandparental childcare if grandchildren were looked after by grandparents on a daily basis or at least 15 hours per week

Methods /3 Self Rated Health (SRH), validated global measure of general health which predicts outcomes such as quality of life and mortality; Functional disability (1+ ADL limitations) is associated with increased morbidity, mortality and health care use; Depression is associated with increased risk of coronary artery disease, cardiovascular death, and worsened quality of life.

Methods /4 STEP 1: Analyses were firstly restricted to participants with complete data [N~6,200 by w3; N~5,300 by w4]. STEP 2: Multiple imputations under the Missing At Random (MAR) assumption were used to explore the effects of missing data. STEP 3: Sensitivity analyses were used to assess whether different ‘arbitrary’ assumptions about the missing data mechanism affected the results. – We assumed that drop-outs were more likely to rate their health as poor or fair/to be depressed/ to report 1+ ADL limitations by 20% and 33%.

Baseline characteristics Gender; Age; Education; Wealth; Possible competing roles (Paid work/ social engagement); Household type; Country; Number & age of grandchildren; Health behaviours (smoking, BMI); Cognitive Function; Diabetes; Stroke. Provision of childcare to grandchildren (w2) Follow-up (w3; w4) SRH as fair or poor 1+ ADL limitations Depression Overview of Analysis SRH as fair or poor 1+ ADL limitations Depression

Results – descriptive /1 Distribution of grandparent childcare, by wave and gender Wave 1 Wave 2 GP childcareMWTotal MW Not looking after Not intensive Intensive Total 6,1678,39314,560 3,5344,9518,485

Results – descriptive /2 Distribution of grandparent’s health, by childcare

Results – logistic regressions /1 Odds Ratios from models of SRH (at waves 3 and 4), ADL limitations (wave 4) and depression (wave 4) Women more likely to report depressive symptoms; Age gradient for SRH (w4) and limitations; Respondents in high education, in paid work, socially engaged and in the highest quintiles of wealth were less likely to report poor health (both at w3 and w4) – no similar patterns found for ADL and depression; Age and number of grandchildren not associated with outcome variables.

SRH w3SRH w4ADL w4Depressed With adult children Alone ** 0.84* Coresiding Not intensive childcare * Intensive childcare0.77* SRH fair/poor5.25** 3.99** 1.99** 1.73** 1+ ADL Limitations1.80** 1.59** 3.81** 1.17 Depressed1.71** 1.80** 1.51** 4.08** Lowest Cognitive function ** 1.63** 1.21 Diabetes1.88** 1.79** 1.56** 1.14 Stroke1.83** 2.08** 2.14** 1.26 Obese1.54** 1.39** 1.83** 0.97 Smoker1.45** 1.39** ** N6,224 5,381 5,380 5,333 Results – logistic regressions /1 Odds Ratios from models of SRH (at waves 3 and 4), ADL limitations (wave 4) and depression (wave 4) * p<0.05; ** p<0.01

MI & Sensitivity analysis The results reported above come from complete-record analyses. Item response was a minor issue: at baseline, about 6% were missing one or more of the variables used; However, sample attrition was quite considerable: ~36% by w2, ~51% by w4; Missing values at follow-up were imputed under MAR and NMAR assumption.

SRH w3 SRH w4 ADL w4Depressed w4 MAR 20%33% MAR 20%33% MAR 20%33% MAR 20%33% W/ adult children ** Alone ** Coreside ** 1.51 * Not intensive 0.86 * 0.85 ** 0.86 * 0.87 * 0.86 * * Intensive childcare 0.83 * * 0.79 * * 0.81 * Results – logistic regressions /2 Odds Ratios from fully adjusted logistic regression with imputed datasets under MAR and MNAR * p<0.05; ** p<0.01

Conclusions i)No negative effect of caregiving on health can be found; actually, analyses suggest that provision of childcare –both intensive and non-intensive –is positively associated with good SRH over time; ii)Living together with grandchild is not associated with worse health outcomes once baseline health is controlled for; iii)Attrition should not be ignored as this might affect some longitudinal associations; iv)MI under MAR and NMAR suggest that childcare provision is beneficial also for grandparents’ functional and mental health.

Limitations No information on type of childcare provided and its quality; nor on the satisfaction or “obligation” perceived by grandparents in looking after their grandchildren; Childcare and health measurements are self- reported and sensitive to the time frame they refer to; Caution is needed when analysing results from MI as we are imputing half the dataset!

Thanks for your attention! Questions, comments and feedback are welcome.

Results – descriptive /2 Distribution of changes in grandparent childcare, by gender Wave 1/ Wave 2 GP childcareMenWomenTotal Not childcare at either wave No care  Any care Continued not-intensive care Continued intensive care Stopped care Non intensive  Intensive Intensive  Not intensive Total3,5184,932100